Cannabis Intoxication
DSM-III For more information, see Intoxication Diagnostic Criteria A'''. Recent use of cannabis. '''B. Tachycardia. C'''. At least one of the following psychological symptoms within 2 hours of use: # euphoria # subjective intensification of perceptions # sensation of slowed time # apathy '''D. At least one of the following physical symptoms within 2 hours of substance use: # conjunctival injection # increased appetite # dry mouth E'''. Maladaptive behavioral effects, e.g., excessive anxiety, suspiciousness or paranoid ideation, impaired judgment, interference with social or occupational functioning. '''F. Not due to any other physical or mental disorder. Differential Diagnosis Other Substance-induced Intoxications should be considered. The individual with Cannabis Intoxication will sometimes have the characteristic sweet smell of burned cannabis on his or her clothing. Alcohol Intoxication frequently decreases appetite, increases aggressive behavior, produces nystagmus or ataxia, and is associated with the smell of alcohol, whereas these symptoms are rare in Cannabis Intoxication. Hallucinogens in low doses cause a clinical picture that resembles Cannabis Intoxication. If the administration was by smoking, this would indicate Cannabis Intoxication, since hallucinogens are not smoked. If administration was by ingestion, Cannabis Intoxication still must be considered. DSM-IV For more information, see'' Substance Intoxication'' The essential feature of Cannabis Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, cannabis use (Criteria A and B). Intoxication typically begins with a "high" feeling followed by symptoms that include euphoria with inappropriate laughter and grandiosity, sedation, lethargy, impaired judgement, distorted sensory perceptions, impaired motor performance, and the sensation that time is passing slowly. Occasionally, anxiety (which can be severe), dysphoria, or social withdrawal occurs. These psychoactive effects are accompanied by two or more of the following signs, developing within 2 hours of cannabis use: conjunctival injection, increased appetite, dry mouth, and tachycardia (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D). Intoxication develops within minutes if the cannabis is smoked, but may take a few hours to develop if ingested orally. The effects usually last 3-4 hours, the duration being somewhat longer when the substance is ingested orally. The magnitude of the behavoral and physiological changes depends on the dose, the method of administration, and the individual characteristics of the person using the substance, such as rate of absorption, tolerance, and sensitivity to the effects of the substance. Because most cannabinoids, including delta-9-THC, are fat soluble, the effects of cannabis or hashish may occasionally persist or reoccur for 12-24 hours due to a slow release of psychoactive substances from fatty tissue or to enterohepatic circulation. Diagnostic Criteria A'''. Recent use of cannabis. '''B. Clinically significant maladaptive behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, social withdrawal) that developed during, or shortly after, cannabis use. C'''. Two (or more) of the following signs, developing within 2 hours of cannabis use: # conjunctival injection # increased appetite # dry mouth # tachycardia '''D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: * With Perceptual Disturbances Specifier The following specifier may be applied to a diagnosis of Cannabis Intoxication: With Perceptual Disturbances This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered. DSM-5 Diagnostic Criteria A'''. Recent use of cannabis. '''B. Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgement, social withdrawal) that developed during, or shortly after, cannabis use. C'''. Two (or more) of the following signs or symptoms developing within 2 hours of cannabis use: # Conjunctival injection. # Increased appetite. # Dry mouth. # Tachycardia. '''D. The signs and symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Specify if: * With perpetual disturbances: Hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Specifiers When hallucinations occur in the absence of intact reality testing, a diagnosis of substance/medication-induced psychotic disorder should be considered. Differential Diagnosis Note that if the clinical presentation includes hallucinations in the absence of intact reality testing, a diagnosis of substance/medication-induced psychotic disorder should be considered. Other substance intoxication Cannabis intoxication may resemble intoxication with other types of substances. However, in contrast to cannabis intoxication, alcohol intoxication and sedative, hypnotic, or anxiolytic intoxication frequently decrease appetite, increase aggressive behavior, and produce nystagmus or ataxia. Hallucinogens in low doses may cause a clinical picture that resembles cannabis intoxication. Phencyclidine, like cannabis, can be smoked and also causes perceptual changes, but phencyclidine intoxication is much more likely to cause ataxia and aggressive behavior. Other cannabis-induced disorders Cannabis intoxication is distinguished from the other cannabis-induced disorders (e.g., cannabis-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.